Ali Konmal, Sakowitz Sara, Chervu Nikhil L, Verma Arjun, Bakhtiyar Syed Shahyan, Curry Joanna, Cho Nam Yong, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Calif.
Department of Surgery, University of California, Los Angeles, Calif.
JTCVS Open. 2023 Sep 22;16:965-975. doi: 10.1016/j.xjon.2023.09.019. eCollection 2023 Dec.
The number of adults with dementia is rising worldwide. Although dementia has been linked with inferior outcomes following various operations, this phenomenon has not been fully elucidated among patients undergoing elective lung resection. Using a national cohort, we evaluated the association of dementia with clinical and financial outcomes following lobectomy for cancer.
Adults undergoing lobectomy for lung cancer were identified within the 2010-2020 Nationwide Readmissions Database. Patients with a comorbid diagnosis of dementia were considered the Dementia cohort (others: Non-Dementia). Multivariable regressions were developed to evaluate the association between dementia and key outcomes.
Of ∼314,436 patients, 2863 (0.9%) comprised the Dementia cohort. Compared with Non-Dementia, the Dementia cohort was older (75 vs 68 years, < .001), less commonly female (49.4 vs 53.9%, = .01), and had a greater burden of comorbid conditions. After adjustment, dementia remained associated with similar odds of in-hospital mortality (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.54-1.38) but greater likelihood of pneumonia (aOR, 1.31; CI, 1.04-1.65) and infectious complications (aOR, 1.37; CI, 1.01-1.87). Further, dementia was associated with longer length of stay (β +0.96 days; CI, 0.51-1.41), but no difference in hospitalization cost (β $1528; CI, -92 to 3148).
Patients with dementia faced similar odds of mortality, but greater complications and resource use following lobectomy for lung cancer. Novel interventions are needed to improve care coordination and develop standardized recovery pathways for this growing cohort.
全球范围内患痴呆症的成年人数量正在上升。尽管痴呆症与各种手术后的不良预后有关，但在接受择期肺切除术的患者中，这一现象尚未得到充分阐明。我们利用一个全国性队列，评估了痴呆症与癌症肺叶切除术后临床及经济预后之间的关联。
在2010 - 2020年全国再入院数据库中识别出接受肺癌肺叶切除术的成年人。患有痴呆症合并诊断的患者被视为痴呆症队列（其他患者为非痴呆症队列）。开展多变量回归分析以评估痴呆症与关键预后之间的关联。
在约314436名患者中，2863名（0.9%）组成了痴呆症队列。与非痴呆症队列相比，痴呆症队列患者年龄更大（75岁对68岁，P < 0.001），女性比例更低（49.4%对53.9%，P = 0.01），合并症负担更重。调整后，痴呆症仍与院内死亡几率相似（调整优势比[aOR]为0.86；95%置信区间[CI]为0.54 - 1.38），但肺炎发生可能性更大（aOR为1.31；CI为1.04 - 1.65）以及感染性并发症发生可能性更大（aOR为1.37；CI为1.01 - 1.87）。此外，痴呆症与住院时间延长相关（β +0.96天；CI为0.51 - 1.41），但住院费用无差异（β为1528美元；CI为 - 92至3148美元）。
痴呆症患者在肺癌肺叶切除术后面临的死亡几率相似，但并发症更多且资源利用更多。需要采取新的干预措施来改善护理协调，并为这一不断增长的队列制定标准化的康复路径。
